GRANITE CITY CLINIC CORP (NPI# 1255387957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255387957 |
| Entity Type | Organization |
| Organization Name | GRANITE CITY CLINIC CORP |
| Practice Address |
2044 Madison Ave Suite 27 Granite City IL 62040-4641 |
| Mailing Address |
Po Box 689022 Franklin TN 37068-9022 |
| Practice Telephone | 6184517600 |
| Practice Fax Number | 6184517685 |
| Mailing Telephone | 6157788507 |
| Mailing Fax Number | 6186286877 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-02-17 |
| Authorized Official Name | MR. MICHAEL SWAW (DIRECTOR) |
| Authorized Official Telephone | 6157788076 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598248106 | Granite City Clinic Corp | Clinic/Center | 602 Farrish St, Madison, IL 62060-1567 | 2018-09-10 |
| 1003892464 | Granite City Clinic Corp | Anesthesiology | 2100 Madison Ave, Granite City, IL 62040-4701 | 2005-12-19 |
| Street Address |
2044 MADISON AVE SUITE 27 |
| City | GRANITE CITY |
| State | IL |
| Zip Code | 62040-4641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851383301 | Michael C Adams | Internal Medicine | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2005-08-19 |
| 1316366594 | Biomedical Imaging, LLC | Physiological Laboratory | 2044 Madison Ave, Suite 28, Granite City, IL 62040-4641 | 2014-04-15 |
| 1922233576 | Elizabeth Patricia Mincy | Nurse Practitioner | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2009-05-27 |
| 1528222437 | Paul Joseph Pace | Surgery | 2044 Madison Ave, Suite 27, Granite City, IL 62040-4641 | 2008-07-10 |
| 1023292000 | Granite City Orthopedic Physicians Company LLC | Durable Medical Equipment & Medical Supplies | 2044 Madison Ave, Granite City, IL 62040-4641 | 2007-12-26 |
| 1487847638 | Fairview Heights Medical Group Sc | Urology | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-08-21 |
| 1508079328 | Debra Ann Clark | Registered Nurse | 2044 Madison Ave, Suite G7, Granite City, IL 62040-4641 | 2007-05-08 |
| 1508983214 | Granite City Physicians Corp | Clinical Medical Laboratory | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-03-26 |
| 1184741142 | Bijoy Hegde Md, PC | Physical Medicine & Rehabilitation | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-03-23 |
| 1710036025 | Irmady Bijoy Hegde | Physical Medicine & Rehabilitation | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043736705 | Christine S Bieniecki Canada | Speech-Language Pathologist | 2300 West 25th St, Granite City, IL 62040 | 2017-08-15 |
| 1881085819 | James Watson | Counselor | 50 Northgate Industrial Drive, Granite City, IL 62040 | 2015-02-12 |
| 1518208719 | Chestnut Health Systems | Clinic/Center | 110 Northagte Industrial Drive, Granite City, IL 62040 | 2013-03-13 |
| 1952651697 | Victor Manuel Pinones | Dentist | 2130 Johnson Rd., Granite City, IL 62040 | 2012-09-10 |
| 1427360502 | Erin K Boerm | Occupational Therapist | 3540 Village Lane, Granite City, IL 62040 | 2010-07-06 |
| 1659503027 | Toni Lyn Siler | Counselor | 101 Whitsell Way, Apt 102, Pontoon Beach, IL 62040 | 2009-08-18 |
| 1871741462 | Fountain View Manor LLC | Alzheimer Center (Dementia Center) | 3432 Village Lane, Granite City, IL 62040 | 2008-09-08 |
| 1083880595 | Christina Marie Darin | Chiropractor | 2013 Johnson Road, Suite C & D, Granite City, IL 62040 | 2008-05-05 |
| 1629244322 | Julia Elaine Uhring Green | Counselor | 2429 Washinton Ave, Granite City, IL 62040 | 2008-05-02 |
| 1578786117 | John K Parker | Preventive Medicine | Veeder Health Center, 20th and Iowa, Granite City, IL 62040 | 2007-04-11 |
| Find all providers in zip 62040 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568643260 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1832 Cleveland Blvd, Granite City, IL 62040-4500 | 2007-11-21 |
| 1023299153 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1218 19th St, Granite City, IL 62040-4501 | 2007-11-16 |
| 1750562880 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 2054 Edison Ave, Granite City, IL 62040-4540 | 2007-11-16 |
| 1821277658 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 2057 Edison Ave, Suite A, Granite City, IL 62040-4514 | 2007-10-29 |
| 1659366615 | Kevin L Bell | Family Medicine | 2407 Corporate Ctr Ste C, Granite City, IL 62040-4268 | 2005-09-15 |
| 1659552354 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 50 Northgate Industrial Dr, Granite City, IL 62040-6805 | 2007-11-21 |
| 1568597565 | Crisale Cosas | Family Medicine | 2100 Madison Ave, Granite City, IL 62040-4701 | 2007-02-22 |
| 1811087604 | Multi-care Specialists P C | Family Medicine | 3986 Maryville Rd, Granite City, IL 62040-4191 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558969964 | Nicole Kerner | Family Medicine | 310 Brandy Dr, Mackinaw, IL 61755-9707 | 2020-10-16 |
| 1285232991 | Healthy Medical Inc | Family Medicine | 535 N. East St., Suite A, Bradley, IL 60915 | 2020-10-14 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1790390805 | Kimberly Hannah Kupferberg | Family Medicine | 1103 Schaeffer Rd, Long Grove, IL 60047-5153 | 2020-09-15 |
| 1194330977 | Home Doctors for You | Family Medicine | 670 Illinois Blvd, Hoffman Est, IL 60169-3363 | 2020-09-09 |
| 1245844489 | Jovita Zalwango Nassolo | Family Medicine | 116 1/2 N Benton St Apt 2d, Woodstock, IL 60098-3272 | 2020-09-04 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1417565755 | Ghr Total Health and Consulting | Family Medicine | 11336 Mckenna Dr, Frankfort, IL 60423-8096 | 2020-07-22 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| Find all providers with the same taxonomy | ||||
| City | GRANITE CITY |
| Zip Code | 62040 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.